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Yonsei Medical Journal Mar 1990In recent years, the sural nerve biopsy has become a commonly performed procedure in the diagnostic work-up of patients with peripheral neuropathy. This paper reviews... (Review)
Review
In recent years, the sural nerve biopsy has become a commonly performed procedure in the diagnostic work-up of patients with peripheral neuropathy. This paper reviews the diagnostic usefulness and limitations of this procedure. Based on 385 sural nerve biopsies, we found clinically helpful or relevant information in 45% of cases. In 24% of cases, specific diagnoses were obtained, among which vasculitic neuropathy was most common.
Topics: Biopsy; Evaluation Studies as Topic; Histological Techniques; Humans; Peripheral Nervous System Diseases; Spinal Nerves; Sural Nerve
PubMed: 2161168
DOI: 10.3349/ymj.1990.31.1.1 -
Diabetologia Jun 1992The nerve fibre loss, atrophy and injury of diabetic peripheral polyneuropathy and their responses to metabolic intervention have been studied by morphometric analysis...
The nerve fibre loss, atrophy and injury of diabetic peripheral polyneuropathy and their responses to metabolic intervention have been studied by morphometric analysis of sural nerve biopsies. The magnitudes and sources of intra- and inter-individual variation in these morphometric measures have not been investigated previously in a systematic manner. Morphometric parameters of nerve fibre damage were measured in four separate fascicles from bilateral sural nerve specimens obtained post-mortem from 13 diabetic and 13 non-diabetic subjects. Intra- and inter-individual coefficients of variation were computed and compared to the magnitude of the differences between normal and diabetic subjects. Several morphometric variables emerged as highly sensitive and reproducible measures of nerve fibre damage suitable for clinical studies of diabetic peripheral polyneuropathy. These observations provide a rational basis for the design of future clinical trials employing morphometric end-points.
Topics: Autopsy; Biopsy; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Humans; Male; Microscopy, Electron; Middle Aged; Nerve Fibers; Nerve Fibers, Myelinated; Ranvier's Nodes; Reference Values; Sural Nerve
PubMed: 1612230
DOI: 10.1007/BF00400485 -
Journal of Neurology, Neurosurgery, and... Oct 2000
Topics: Biopsy; Humans; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 10990498
DOI: 10.1136/jnnp.69.4.431 -
Journal of Korean Medical Science Feb 2008To enhance the accuracy for determining the precise localization, the findings of the compound nerve action potentials (CNAPs) of the common peroneal nerve (CPN) were...
To enhance the accuracy for determining the precise localization, the findings of the compound nerve action potentials (CNAPs) of the common peroneal nerve (CPN) were investigated in patients with common peroneal mononeuropathy (CPM) in the knee, and the sural sensory nerve action potentials (SNAPs) were also analyzed. Twenty-five patients with CPM in the knee were retrospectively reviewed. The findings of the CNAPs of the CPN recorded at the fibular neck and the sural SNAPs were analyzed. The lesion was localized at the fibular head (abnormal CNAPs) and at or distal to the fibular head (normal CNAPs). Seven patients were diagnosed as having a lesion at or distal to the fibular neck, and 18 cases were diagnosed as having a fibular head lesion. The sural SNAPs were normal in all the cases of lesion at or distal to the fibular neck. Among 18 cases of fibular head lesion, the sural SNAPs were normal in 7 patients: two cases of conduction block and 5 cases of mild axon loss. Eleven patients showed abnormal sural SNAPs. Of those, 9 cases were severe axon loss lesions and 2 patients were diagnosed as having severe axon loss with conduction block. The recording of the CNAPs may enhance precise localization of CPM in the knee. Moreover, the sural SNAPs could be affected by severe axonal lesion at the fibular head.
Topics: Action Potentials; Humans; Peroneal Nerve; Peroneal Neuropathies; Sural Nerve
PubMed: 18303210
DOI: 10.3346/jkms.2008.23.1.117 -
Journal of Diabetes Investigation Sep 2018Studies on a novel point-of-care device for nerve conduction study called DPNCheck have been limited to Westerners. We aimed to clarify Japanese normal limits of nerve... (Comparative Study)
Comparative Study
Difference in normal limit values of nerve conduction parameters between Westerners and Japanese people might need to be considered when diagnosing diabetic polyneuropathy using a Point-of-Care Sural Nerve Conduction Device (NC-stat®/DPNCheck™).
AIM/INTRODUCTION
Studies on a novel point-of-care device for nerve conduction study called DPNCheck have been limited to Westerners. We aimed to clarify Japanese normal limits of nerve action potential amplitude (Amp) and conduction velocity by DPNCheck (investigation I), and the validity of DPNCheck to identify diabetic symmetric sensorimotor polyneuropathy (DSPN; investigation II).
MATERIALS AND METHODS
For investigation I, 463 non-neuropathic Japanese participants underwent DPNCheck examinations. Regression formulas calculating the normal limits of Amp and conduction velocity (Japanese regression formulas [JRF]) were determined by quantile regression and then compared with regression formulas of individuals from the USA (USRF). For investigation II, in 92 Japanese diabetes patients, 'probable DSPN' was diagnosed and nerve conduction abnormalities (NCA1: one or more abnormalities, and NCA2: two abnormalities in Amp and conduction velocity) were determined. Validity of NCAs to identify 'probable DSPN' was evaluated by determining sensitivity, specificity, reproducibility (kappa-coefficient) and the area under the curve of receiver operating characteristic curves.
RESULTS
For investigation I, JRF was different from USRF, and normal limits by JRF were higher than that of USRF. The prevalence of Amp abnormality calculated by JRF was significantly higher than that of USRF. For investigation II, the sensitivity, specificity and reproducibility of NCA1 and NCA2 judged from JRF were 85%, 86% and 0.57, and 43%, 100% and 0.56, respectively. These values of JRF were higher than those of USRF. The area under the curve of JRF (0.89) was larger than USRF (0.82).
CONCLUSIONS
A significant difference in the normal limits of nerve conduction parameters by DPNCheck between Japanese and USA individuals was suggested. Validity to identify DSPN of NCAs might improve by changing the judgment criteria from USRF to JRF.
Topics: Adult; Aged; Asian People; Diabetic Neuropathies; Female; Humans; Japan; Male; Middle Aged; Neural Conduction; Point-of-Care Systems; Polyneuropathies; Reference Values; Sural Nerve; United States; White People
PubMed: 29430866
DOI: 10.1111/jdi.12818 -
Muscle & Nerve Jan 1993Although polyneuropathies associated with IgM and IgG monoclonal gammopathies have been well described, polyneuropathy with IgA monoclonal gammopathy of undetermined... (Review)
Review
Although polyneuropathies associated with IgM and IgG monoclonal gammopathies have been well described, polyneuropathy with IgA monoclonal gammopathy of undetermined significance (MGUS) is less commonly seen and has not been well studied. We reviewed the clinical and electrodiagnostic features of 5 such patients, and the sural nerve biopsy findings in 4 of them. One patient was diabetic, while 4 were free of other diagnoses commonly associated with neuropathy. Clinical presentations were varied. Electrodiagnostic and histological studies ranged from primary demyelination to primary axon loss to a mixed axonal/demyelinating picture. Three patients who were treated appeared to respond to prednisone or intravenous gamma globulin, despite clear clinical, electrodiagnostic, and histological differences. We conclude that the polyneuropathy associated with IgA MGUS is heterogeneous, similar to that in IgM and IgG MGUS. A trial of immunomodulating therapy appears to be warranted in such patients if the neuropathy is sufficiently severe.
Topics: Adult; Aged; Electromyography; Female; Humans; Immunoglobulin A; Male; Neural Conduction; Paraproteinemias; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 8380902
DOI: 10.1002/mus.880160113 -
Journal of Anatomy Apr 1988A study has been made of changes in internodal lengths in rat tibial nerves and human sural nerves with age. Myelinated fibre counts on these nerves showed that maximum...
A study has been made of changes in internodal lengths in rat tibial nerves and human sural nerves with age. Myelinated fibre counts on these nerves showed that maximum numbers were reached at an early stage of development. The slope of regression lines relating internodal length to fibre diameter was relatively flat at this stage, but became steeper with increasing age. Maximum internodal length in rat tibial nerve was closely related to growth of the limb bones. Whilst this study confirms that the largest fibres are subjected to hind limb growth for the greatest period, and therefore have the longest internodes, it does not support the generally accepted view that short internodes are the consequence of the later myelination of small fibres, and hence shorter period of extension due to growth.
Topics: Adolescent; Adult; Age Factors; Aged; Animals; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Middle Aged; Nerve Fibers; Nerve Fibers, Myelinated; Rats; Rats, Inbred Strains; Spinal Nerves; Sural Nerve; Tibial Nerve
PubMed: 3198476
DOI: No ID Found -
Revista Do Colegio Brasileiro de... 2019The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait... (Review)
Review
The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.
Topics: Achilles Tendon; Equinus Deformity; Foot; Humans; Muscle, Skeletal; Sural Nerve; Tenotomy
PubMed: 31017177
DOI: 10.1590/0100-6991e-20192054 -
Archives of Pathology & Laboratory... Jan 2000Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in...
OBJECTIVE
Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in sural nerve biopsies and to evaluate the clinical and pathologic features of these lesions.
METHODS
All available histologic and ultrastructural materials on biopsy tissue from 13 cases of peripheral nerve amyloidosis were examined. Muscle biopsies performed at the same time as the nerve biopsy were reviewed when available. Clinical data were collected on all patients.
RESULTS
The prevalence of amyloidosis in sural nerve biopsies at our institution was 13 (1.2%) of 1098 cases over a 15.8-year period. These patients ranged in age from 41 to 82 years (median, 61 years) at initial presentation and included 10 men and 3 women. Presenting neuropathy symptoms were sensory in 6 of the 13 patients, motor in 2 cases, and mixed in 5 cases. Cardiac, renal, or gastrointestinal involvement was present in 7 of 13 cases. Two patients had myeloma and 7 had systemic autonomic symptoms. Two patients had probable familial amyloid polyneuropathy, and 1 patient demonstrated an alanine 60 point mutation. Amyloid, identified as amorphous eosinophilic extracellular deposits demonstrating apple green birefringence on Congo red stain or recognized by its characteristic fibrillar ultrastructure by electron microscopy, was identified in the endoneurium in 12 nerves, perineurium in 2 nerves, and epineurium in 9 nerves. Chronic inflammation was identified in 5 nerves. Axonal loss was recorded as mild (<25%) in 1 nerve, moderate (25% to 75%) in 8 nerves, and severe (>75%) in 4 nerves. Axonal degeneration predominated over demyelination in 8 of 10 cases that could be evaluated. Concomitant muscle biopsies contained amyloid deposits in 8 of 9 cases.
CONCLUSIONS
Amyloidosis is a rare (1.2% in our series) cause of peripheral neuropathy with a distinct microscopic and ultrastructural appearance. Just over half the patients in our study had visceral organ involvement and systemic autonomic symptoms. The peripheral neuropathy was associated with axonal degeneration and a moderate to severe axonal loss in the majority of cases. Amyloid deposition was present in 8 out of 9 muscle biopsies performed at the same time.
Topics: Adult; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Biopsy, Needle; Congo Red; Female; Humans; Male; Microscopy, Electron; Middle Aged; Muscle, Skeletal; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 10629141
DOI: 10.5858/2000-124-0114-PNAISN -
The Journal of Physiology Apr 19911. The proportion of primary afferent nerve fibres in a skin nerve of the rat that responded or failed to respond to mechanical or thermal stimulation of the skin in the...
1. The proportion of primary afferent nerve fibres in a skin nerve of the rat that responded or failed to respond to mechanical or thermal stimulation of the skin in the noxious and non-noxious range was analysed. 2. Activity of afferent nerve fibres was recorded from the dorsal roots. Units projecting into the sural nerve were selected using supramaximal electrical stimulation of the nerve stem. All other hindleg nerves were cut. 3. The receptive fields were searched by carefully examining the hindleg skin with noxious and innocuous mechanical, cooling and warming stimuli. Probing of the intrinsic foot muscles and manipulation of the ankle and toe joints was employed to recruit units projecting to deeper tissues. 4. In a first series of twenty-two experiments, eighty-nine rapidly conducting myelinated A beta units, thirty slowly conducting myelinated A delta units and 101 unmyelinated C units were investigated. Most units were identified as belonging to one of the established classes of cutaneous sensory units and this was also ascertained by a collision test. 5. Two A beta, eight A delta and forty-six C fibres did not respond to any one of the stimuli. Electrical thresholds and conduction velocities of the unresponsive C fibres were not significantly different from those of the units responding to natural stimulation of their receptive fields. In the A delta group unresponsive and high threshold mechanoreceptive units were preferentially found among the units with the slowest conduction velocities. 6. In a second series of seven experiments, one single nerve filament containing responsive and unresponsive C fibres was tested repetitively at 30 min intervals. Twenty unresponsive units and seven units responding to noxious mechanical and/or heat stimuli were studied. Ten of the twenty initially unresponsive units became activated by mechanical and/or heat stimuli after observation times of 30-150 min. Some of these units had mechanical thresholds as low as 64 mN (tested with calibrated von Frey hairs), or thermal thresholds down to 42 degrees C. 7. Two of the ten C units which became responsive in the course of an experiment later lost their responsiveness again. On the other hand, two of the C units which were initially responsive to noxious heat and/or noxious mechanical stimuli became completely unresponsive after repetitive stimulation, whereas one unit initially only responding to noxious heat became responsive to mechanical stimuli, suggesting that mechanical and heat responsiveness may be separately gained or lost by sensory C fibres.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Animals; Hot Temperature; Mechanoreceptors; Nerve Fibers; Neural Conduction; Physical Stimulation; Rats; Rats, Inbred Strains; Skin; Sural Nerve
PubMed: 1770437
DOI: 10.1113/jphysiol.1991.sp018507